Department of Neurology, Narayana Medical College and Hospital, Nellore, India.
J Clin Neurophysiol. 2012 Apr;29(2):190-3. doi: 10.1097/WNP.0b013e31824d969c.
To assess the relationship between the cross-sectional area (CSA) of the ulnar nerve by ultrasound (US) with clinical and electrophysiologic findings in Hansen ulnar neuropathy.
Twenty-one patients (42 arms) with Hansen disease (mean age 30.0 ± 12.97, range 13-61 years, borderline tuberculoid 29%, borderline lepromatous, 19% lepromatous leprosy 42%, and pure neuritic type 10%) were examined clinically for ulnar sensory and motor weakness. The ulnar nerve was ultrasonographically examined from the wrist to the axilla, and CSA was measured at the level of maximum enlargement. Ulnar sensory nerve conduction was recorded orthodromically with ring electrodes placed at the fifth digit and amplitude of sensory nerve action potential (SNAP) recorded 3 cm proximal to the distal wrist crease. Motor conduction velocity (MCV) was recorded at the wrist-below the elbow, below the elbow-above the elbow, and above the elbow-axilla segments.
Out of the 42 arms with Hansen disease, 76% had clinically motor weakness, and 43% had sensory loss in the upper limbs innervated by the ulnar nerve. As compared with healthy subjects, the patients with Hansen ulnar neuropathy had a statistically significant reduction in SNAP (P ≤ 0.0001) and MCV (P ≤ 0.0001). It was observed that the maximum enlargement of the ulnar nerve in all the patients was a few centimeters above the elbow segment. The mean CSA of ulnar nerve above the medial epicondyle was 18 ± 15 mm as compared with controls 4.83 ± 1.12 mm (P < 0.0001). In addition to nerve thickening, US depicted abnormality in morphology. In 55%, the nerve was hypoechoic, and in 7.1%, the nerve pattern was oligofascicular. Color Doppler (CD) flow signals were observed in all the nerves with loss of fascicular pattern and in 40% of the nerves that were hypoechoic. A statistically significant correlation was found between CSA of ulnar nerve above the medial epicondyle vs. MCV at BE-AE and compound muscle action potentials (CMAP) above the elbow in the patients with clinical motor weakness (r = -0.55, P < 0.001) and (r = -0.57, P < 0.001), respectively. There was no statistical significant correlation between CSA and SNAP in the patients with (r = -0.52, P = 0.23) and without (r = -0.07, P = 0.83) sensory loss.
In leprosy patients, a positive correlation exits between the presence of motor weaknesses of the ulnar nerve innervated muscles, sonographically thickening of the ulnar nerve, and motor conduction slowing of the ulnar nerve at the BE-AE segment. In addition, US provided information on nerve morphologic alterations regarding the echo texture and location of nerve enlargement.
评估超声（US）测量的尺神经横截面积（CSA）与 Hansen 尺神经病的临床和电生理表现之间的关系。
对 21 例（42 侧）患有 Hansen 病（平均年龄 30.0±12.97 岁，范围 13-61 岁，边界结核样 29%，边界瘤型 19%，瘤型麻风 42%，单纯神经型 10%）的患者进行临床尺神经感觉和运动无力评估。从腕部至腋窝对尺神经进行超声检查，并在最大肿胀处测量 CSA。采用环电极在第 5 指记录尺神经感觉神经传导，在远侧腕皱褶近端 3cm 处记录感觉神经动作电位（SNAP）的振幅。在腕部-肘部以下、肘部-肘部以上和肘部-腋窝段记录运动传导速度（MCV）。
在 42 只患有 Hansen 病的手臂中，76%存在运动无力，43%上肢尺神经支配区有感觉丧失。与健康对照组相比，Hansen 尺神经病患者的 SNAP（P≤0.0001）和 MCV（P≤0.0001）明显降低。所有患者的尺神经最大肿胀均在肘部以上几厘米处。内上髁上方尺神经的平均 CSA 为 18±15mm，而对照组为 4.83±1.12mm（P<0.0001）。除了神经增粗，US 还显示了形态异常。55%的神经呈低回声，7.1%的神经呈寡神经束状。在所有失去束状模式的神经和 71%的低回声神经中都观察到彩色多普勒（CD）血流信号。在临床运动无力的患者中，尺神经 CSA 与 BE-AE 段 MCV 和肘部以上复合肌肉动作电位（CMAP）之间存在统计学显著相关性（r=-0.55，P<0.001）和（r=-0.57，P<0.001）。在有（r=-0.52，P=0.23）和无（r=-0.07，P=0.83）感觉丧失的患者中，CSA 与 SNAP 之间无统计学显著相关性。
在麻风病患者中，尺神经支配肌肉的运动无力、尺神经超声增厚以及 BE-AE 段尺神经运动传导速度减慢之间存在正相关。此外，US 提供了有关神经形态改变的信息，包括神经回声纹理和神经肿大的位置。
